MEDICARE: EARLY DYNAMICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency
2	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1083138358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY DYNAMICS

Provider Business Mailing Address
First Line	:	5116 N NORDICA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-3606
Country	:	US
Telephone Number	:	773-750-0982
Fax Number	:

Provider Business Practice Location Address
First Line	:	5116 N NORDICA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-3606
Country	:	US
Telephone Number	:	773-750-0982
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HILDA ESTRADA
Credential	:	NONE
Telephone Number	:	773-750-0982

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	03/03/2026

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Directions to “EARLY DYNAMICS ” Practice Location

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